Take
Home Message: Time, financial cost, availability of literature, lack of
knowledge, and working relationships with other health care professionals are
common barriers to incorporating evidence-based practice for a clinician.

Evidence-based practice (EBP) has become increasingly important as health care
professions have evolved. Athletic training has been no exception, as the
release of the fifth edition of the Athletic Training Educational Competencies has
placed specific emphasis on incorporating EBP in curriculums. Clinicians in a
variety of health care professions have reported challenges in using EBP. This
struggle, coupled with the importance of students interacting with their
clinical preceptors to learn EBP, is why the authors of this qualitative study wanted
to identify common barriers that clinical preceptors encounter when trying to
implement EBP in clinical practice and teach EBP to athletic training students.
The authors identified 16 clinical preceptors who had at least one year of
experience with an undergraduate athletic training education program and indicated
that they utilized the five steps of EBP. The
interviewer used a semi-structured set of questions during the phone interviews,
which were recorded and transcribed. The authors identified two main themes
regarding the barriers to clinical integration of EBP and how preceptors view
the emphasis placed on EBP in educational curriculum. With regards to barriers
to clinical integration of EBP, preceptors noted that time, financial
restrictions, availability of relative information, and lack of knowledge kept
them from using EBP both clinically and with students. Additionally, preceptors
identified personnel challenges as a barrier; meaning preceptors felt their
working relationships with other staff, coaches, physicians, etc. impeded them
from implementing EBP. Furthermore, preceptors indicated that older students
(junior, senior level) were more receptive to implementing EBP as a result of
their improved clinical experience. From an educational perspective, preceptors
noted that improvements to academic programs and communication could help EBP
become a more substantial part of the curriculum. More specifically, the
authors noted that a better connection between clinic and classroom, as well as
improved communication between clinical staff and education faculty, may be beneficial.

There is disconnect between the increased
emphasis of EBP in athletic training educational curricula and its integration by
clinical preceptors; apparent even among clinicians who were chosen because
they utilized EBP. Of specific concern is that these clinicians cited working
relationships with other health care professionals as a barrier to their own
EBP. The entire sports medicine team must support the use of EBP for it to be
fully integrated into our medical practice. However, it is understandable that
these preceptors struggle with colleagues to implement EBP when their
colleagues and they have limited resources (time and money) to access the
latest evidence. Additionally, the authors noted that preceptor training
appears to be a common place where EBP is discussed but a better connection
needs to be made between clinic and classroom. As athletic training education continues to
make a shift to separate clinical staff and educational faculty, and as the
diversity of practice settings outside the traditional college athletic
training room evolve, it will be imperative that communication remains
consistent between those teaching EBP in the classroom and those integrating it
into students’ clinical experiences. What methods/habits do you use to
incorporate EBP into your own practice or with your students? What challenges
do you face with attempting to utilize EBP?

7
comments:

Laura, thanks for the great post. It makes me wonder if local journal clubs, hosted by the education programs, would be a good way to help improve communication between the clinical staff and classroom faculty. Furthermore, opening up the journal clubs to other healthcare providers in the local sports medicine community might help address the personnel challenges the authors describe. When I was working in a clinic we did a monthly journal club before office hours and I think it was a good opportunity for us to discuss the selected studies and also for us to discuss what we were doing in clinical practice and to share ideas.

If there's concerns about finding an hour or two at a set time each month then perhaps an online journal club could be another option. This would allow people to join in the discussion on their own schedule. To alleviate the cost issues, the articles could be open access articles so that everyone can download the article for free. SMR would be glad to set up a page if there's interest in 1-2 articles being selected each month for an online journal club.

The barriers the authors describe will be challenging to overcome but we'll be able to overcome them.

Terrific post. I love the ideas that Jeffery is bringing to the table and hope too that these issues are soon resolved. I (like Jason) would like to reference this article in a paper I will be writing and hope to also be granted the same permissions. Thank you!

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